Effectiveness of nulliparous women's different childbirth positions during the second stage of labor: A systematic review and network meta-analysis

Abstract

Objectives: A systematic review and network meta-analysis was conducted to evaluate the effectiveness of different childbirth positions in reducing the duration of the second stage of labor, providing evidence-based insights for obstetric institutions to guide interventions related to childbirth positions.

Methods: A comprehensive literature search was conducted in databases, including PubMed, Web of Science, the Cochrane Library, Embase, Wanfang Databases, China National Knowledge Infrastructure Databases (CNKI), China Science and Technology Journal Database (CSTJ), and China Biology Medicine disc (CBMdisc) to identify studies on the effectiveness of different childbirth positions in reducing the duration of the second stage of labor. The search included randomized controlled trials published from database inception to September 30, 2024. The Cochrane risk-of-bias tool was used to assess the quality of the studies. Two independent reviewers screened the literature, extracted data, and evaluated study quality. Subsequently, a network meta-analysis was performed using STATA software. The study protocol has been registered in PROSPERO (CRD42023428217).

Results: This study analyzed data from 25 randomized controlled trials involving 9,844 women. The findings indicated that in comparison to lithotomy position, free position (MD = 20.53, 95 %CI [11.38, 29.68]) and upright position (MD = -24.13, 95 %CI [-42.94, -5.32]) were found to be superior in reducing the duration of the second stage of labor. Free position outperformed kneeling position (MD = 21.48, 95 %CI [4.67, 38.28]) and squatting position (MD = 23.43, 95 %CI [1.88, 44.97]); upright position was superior to kneeling position (MD = -25.08, 95 %CI [-46.93, -3.22]); semirecumbent position surpassed squatting position (MD = 19.71, 95 %CI [2.05, 37.38]); and upright position was also superior to squatting position (MD = -27.03, 95 %CI [-51.48, -2.57]). According to the surface under the cumulative ranking curve (SUCRA), the upright position emerged as the most effective for reducing the duration of the second stage of labor (87.4 %), followed by free position (81.1 %), semirecumbent position (70.0 %), and lateral position (62.3 %).

Conclusion: These findings offer valuable insights for midwifery practice and help inform future research directions. Considering the limitations of this review, more larger-scale, multicenter randomized controlled trials are warranted to further evaluate the relative effectiveness of different childbirth positions in reducing the duration of the second stage of labor.

Keywords: Childbirth; Network meta-analysis; Nulliparous women; Position; Second stage of labor.

Fig. 1

The flow chart of literature selection.

Fig. 2

Network meta-analyses comparing the duration of the second stage of labor. Note: The data presented are the MD with 95 %CI for the column-defining positions compared with the row-defining positions (e.g., the effect of the free position relative to the kneeling position is 21.48 in terms of effectiveness). Positions are ranked according to the SUCRA for the duration of the second stage of labor. Data in bold show comparisons that are statistically significant. Comparisons between positions should be read from left to right. For the duration of the second stage of labor, an MD more than 0 favors the column-defining position. MD = mean difference. SUCRA = surface under the cumulative ranking curve.